Factors Affecting Success and Results of Cartilage-Perichondrium Island Graft in Revision Tympanoplasty

Abstract

OBJECTIVE: The chance of complete postoperative healing of the tympanic membrane is relatively low due to poor blood supply of the graft in patients who undergo revision tympanoplasty. The aim of this study is to assess postoperative healing and the factors affecting closure of the tympanic membrane and hearing gain after revision tympanoplasty with cartilage-perichondrium island graft. MATERIALS and METHODS: This study was conducted as a retrospective review of charts of patients who underwent revision tympanoplasty with composite cartilage-perichondrium island graft at our clinic. Patients who underwent radical or modified radical mastoidectomy for the treatment of cholesteatoma and who had stapes fixation were excluded. All grafts were placed using over-under technique. Ossiculoplasty and mastoidectomy were performed as needed. Closure of the tympanic membrane and hearing thresholds were evaluated at the end of postoperative year 1. RESULTS: Thirty-three cases, 14 females and 19 males with mean age 37.5 +/- 12.7, were included in the study. Ossiculoplasty was performed in 8 cases, and mastoidectomy was added to tympanoplasty in 12 cases. Tympanic membrane was intact in 29 cases (87.4%) in the 12th postoperative month. Large perforation, adhesive tympanic membrane, and especially hypertrophic middle ear mucosa were found to have negative impact on success of graft (p<0.01). The success of graft in patients with mastoidectomy was lower than without mastoidectomy (p<0.001). Age (p=0.491), gender (p=0.567), surgical approach (p=0.378), and the number of operations (p=0.283) did not contribute to the success of the graft. Average improvement of postoperative air conduction hearing threshold was 13.2 +/- 5.5 dB, and average decrease in air bone gap was 11.7 +/- 5.5 dB. CONCLUSION: Postoperative closure rate of the tympanic membrane was high and audiologic improvement was satisfactory with cartilage-perichondrium island graft in revision tympanoplasty. Cartilage-perichondrium island graft may be preferred for reconstruction of the tympanic membrane because of its resistance to inflammation and poor feeding in revision tympanoplasty.